Medicare data will help public fight fraud, officials say

Apr. 10, 2014
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President Obama makes a statement in the Roosevelt Room of the White House on Nov. 15, 2013, before the start of a meeting with representatives of health insurance companies. At left are Michael Hash, senior adviser of Health and Human Services Office of Health Reform, and Marilyn Tavenner, head of the Centers for Medicare and Medicaid Services. / Evan Vucci, AP

by Kelly Kennedy, USA TODAY

by Kelly Kennedy, USA TODAY

WASHINGTON - The government released Medicare payment data for 880,000 providers Wednesday in part so that the public - and journalists - could double-check the information for fraud, officials said Wednesday.

"We know that there's waste in the system, we know that there's fraud in the system," said Jonathan Blum, principal deputy administrator for the Centers for Medicare and Medicaid Services. "We want the public's help - we want reporters' help - with data that appear to be fraudulent."

For the past 35 years, the data have been kept from the public because the American Medical Association feared that people would not understand the data. Privacy was another concern.

The secrecy led to questions about how government money was being spent, Blum said. "For too long, this data was not public," he said. "The Medicare program is funded, by and large, with taxpayer dollars."

Despite the release, patient privacy will be maintained, Blum said.

Researchers will now be able to look at how payments vary by geography, as well as why some providers get paid more, he said.

"There's some spending that just appears to be wasteful," said Niall Brennan, acting director of CMS' Offices of Enterprise Management. "Our goal is to sharpen the conversation. People should not jump to conclusions just by seeing spikes in spending."

Researchers could also look at why more money is spent on drugs or procedures in one part of the country compared with another, and whether that leads to increased quality in care. Brennan said updated data on hospital charges would be released within the next two months.

Officials also say they released the data so consumers would have a better understanding of how providers bill their customers. Because of the Affordable Care Act, as well as both employers' and consumers' moves toward high-deductible plans, it's important for people to understand costs for medical procedures so they can shop for the best prices.

"Currently, consumers have limited information about how physicians and other health care professionals practice medicine," said Kathleen Sebelius, secretary of Health and Human Services. "This data will help fill that gap by offering insight into the Medicare portion of a physician's practice."

Government officials had feared a last-minute court order forbidding the release, but none came.

The data set includes $77 billion in Medicare payments from 2012 for Medicare Part B fee-for-service providers. It gives providers' names, specialties, addresses, billing, average price per beneficiary and number of beneficiaries.

Immediately after the release of data for 880,000 Medicare providers early Wednesday morning, advocates of the move praised the government's transparency, while opponents said consumers could misinterpret the data and that doctors had privacy concerns.

"Data transparency is a key aspect of transformation of the health care delivery system," said Marilyn Tavenner, Centers for Medicare and Medicaid Services administrator. "While there's more work ahead, this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program."

But Susan Turney, president of the Medical Management Group Association, said the data need "proper context and safeguards" or the information will be "detrimental to patients and physicians."

"MGMA is troubled about the potential for unintended consequences as a result of the release of this type of data and the effect it may have on Medicare beneficiaries," Turney said. "This release could result in patients making decisions about their care based on faulty assumptions about physicians. Claims data are not a proxy for quality, especially when provided in isolation, from a single payer."

Gail Wilensky, former Medicare program director under President George H.W. Bush, said that argument has been made before about medical data and that the fears were unfounded. She said transparency outweighs the potential damage. However, she agreed with MGMA's concern that provider data may be incorrect and said there should be a quick way to correct information.

Linda Burns, president of the American Society of Hematology, said she supports greater transparency but also thinks the data should be explained better to consumers.

"Specifically, the numbers alone will not explain quality of care or account for specific drivers of cost such as specialty, location, supply costs and support staff," she said. "Data must be presented in the proper context to be valuable to the overall improvement of the U.S. health care system."